Provider Demographics
NPI:1104209683
Name:LEIJA, ROXANA RODRIGUEZ (OD)
Entity Type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:RODRIGUEZ
Last Name:LEIJA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4900 BEE CREEK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-6776
Mailing Address - Country:US
Mailing Address - Phone:512-744-6274
Mailing Address - Fax:512-744-6319
Practice Address - Street 1:4900 BEE CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6776
Practice Address - Country:US
Practice Address - Phone:512-744-6274
Practice Address - Fax:512-744-6319
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8724T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist